It’s estimated that 1.5% of the global population has dissociative identity disorder (DID). This disorder is relatively rare, but it’s often misdiagnosed and may never be diagnosed at all.

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Until 1994, DID was called Multiple Personality Disorder. It’s a very misunderstood disorder that only recently has been taken seriously. Thanks to people sharing their experiences in online communities and increased research, DID is now more understood than ever before. 

What is Dissociative Identity Disorder?

Dissociative identity disorder (DID) is a form of dissociative disorder that affects a person’s ability to connect to reality. People with DID have at least two distinct personalities that can control a person's behavior at different times. 

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Alternate identities tend to be different from one another and the host. They could be different genders and ethnicity, and they tend to relate to reality in different ways. Someone with DID can have over 100 alternate identities.

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Someone with DID can switch between these different personalities—often referred to as headmates—at random. Some people can control when these switches happen more than others. However, these switches can be distressing, especially if the host is unaware of their alternate identities. 

Terminology and Definitions

While learning about DID, it’s important to understand the terms used while talking about DID. 

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• Host: The main personality. This is considered the “original personality”
• System: Often used online to refer to all alters, or parts, of a person with DID, including the host
• Alternate Identities, Alters, or Headmates: These terms each refer to the other personalities within a system
• Fronting: When the host switches to an alternate, that alternate is considered to be fronting
• Switch or Switching: When the host or the fronting alternate no longer has control of the body and a different alternate begins fronting

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Many of these terms have been created and used within online forums and communities dedicated to helping and creating a community for those with DID.

What Causes Dissociative Identity Disorder

DID is typically developed in individuals who experienced long-term trauma during childhood. These traumas could include:

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• Neglect
• Physical abuse
• Natural disasters
• Witnessing the abuse of another
• Unpredictable caregivers
• Sexual abuse
• Wartime

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To cope with living through trauma, some children may take on different behaviors or identities to protect themself. While they take on these behaviors, they’re actually dissociating from the trauma that is occurring. As these children grow up, their behaviors will become fully formed alternates. 

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DID is mostly a coping mechanism used to protect the host from the difficulties of trauma. 

Harmful Stereotypes and Common Misconceptions of DID 

DID is an incredibly misunderstood and misrepresented disorder. Like most mental health disorders, people with DID are often portrayed as villainous. They’re shown as irrational, violent, and impulsive people. This is not the truth.

Violent or Erratic Behavior

The most common portrayal of DID is violent or erratic behavior. The person with DID could change at any moment and the people around them are on edge over which alter will front next. This couldn’t be farther from the truth. 

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People with DID are not any more dangerous than any other person and switching can take seconds, minutes, or even days. Switches can also be subtle, and most observers won’t be able to recognize them. 

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Alters are not monsters that give the host unnatural powers or bloodlust. These portrayals are harmful to those who experience DID and spread misinformation about what this disorder is.

DID is Schizophrenia

Schizophrenia spectrum disorders are different from DID. Schizophrenia is a disorder that produces symptoms that make it difficult to understand reality. Those symptoms include:

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• Hallucinations
• Withdrawn symptoms
• Disorganized speech or thinking
• Grossly disorganized or abnormal behavior
• Delusions

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The confusion between DID and schizophrenia is the auditory hallucinations most people with schizophrenia experience. While someone with DID may be able to hear the voice of an alter, it’s not the same as auditory hallucinations. 

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Schizophrenia and DID are two different disorders and they should not be confused or placed in the same category.

Symptoms of Dissociative Identity Disorder

While DID is often hard to recognize, there are common symptoms that a mental health professional can identify to help find a diagnosis.

Memory Loss

One of the most distressing symptoms of DID is memory loss.

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DID often works as a defense mechanism for living through trauma. Traumatic memories are hard to process, that’s why they’re often re-lived through flashbacks. To combat trauma, people with DID will dissociate by subconsciously letting an alter front. Because the host was dissociated during the trauma, they can’t remember it. The traumatic memory is stored in the brain, but it’s not accessible by the host.  

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As the person gets older, alters may begin fronting during times that aren’t necessarily traumatic, leaving certain blank spaces throughout the host's memory.

Anxiety and Depression

Someone with DID may experience anxiety and depression as a result of their unknown disorder. Dissociation can leave people feeling numb, lost, and confused. Experiencing it often only exacerbates those feelings.

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While someone unknowingly lives with DID, they’re more likely to experience these symptoms, and this may be the reason why many individuals with DID seek treatment. 

Self-harm or Suicidal Ideation

Those with DID are more likely to harm themselves than harm other people. Most people with DID report engaging in self-harm. Trauma-related cues are the main reason for this, but 92.31% of these people reported being at least partially unaware of the reason for their self-injury tendencies.

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If you or a loved one are experiencing suicidal ideation, you can call the Suicide and Crisis Lifeline by dialing 988. This lifeline will connect you to local crisis centers that provide confidential and free emotional support. Call 911 if you or a loved one is experiencing an immediate emergency.

Dissociative Disorders

Disorders that create a feeling of losing the connection between thoughts, feelings, surroundings, behavior, identity, and memory are considered dissociative disorders. 

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Dissociation is a natural response that some people have to trauma. It may feel like a disconnection between:

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• Thoughts
• Feelings
• Surroundings
• Behaviors
• Memory
• Identity 

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Some may feel a brain fog surrounding their thoughts, others may explain it as an out-of-body experience.

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Three disorders fall under the category of dissociative disorders:

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• Dissociative amnesia
• Depersonalization-derealization disorder
• Dissociative identity disorder

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Below, we’ll discuss each condition and how they relate to each other.

Dissociative Amnesia

This disorder is characterized by memory gaps and an inability to recall personal information. This disorder is similar to DID but without the addition of alternate identities.

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Dissociative amnesia often occurs while other conditions are present and is often associated with type B and C personality disorders.

Depersonalization-Derealization Disorder 

Depersonalization-derealization disorder (DDD) is what most people associate with dissociating.

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This disorder occurs when someone often or always feels like they’re experiencing life from outside of their body and that the things around them are not real. These symptoms can be quite distressing to live through and can make daily functions difficult.

Dissociative Identity Disorder Treatment

DID cannot be cured, but treatment can make symptoms much more manageable. Like most mental health conditions, a holistic treatment that considers physical and mental needs is the best approach.

Dissociative Identity Disorder Therapies

Psychotherapy is standard practice for DID treatment. 

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During psychotherapy, the patient will be educated on how their disorder works as given terms to help them explain their experience better. This is called psychoeducation and it helps patients accept their disorder and understand themselves better.

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There are several talk therapies used to treat DID. Below you’ll find an explanation of some of the therapies used.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) helps patients connect their thoughts to their emotions to their behavior. From there they’re better able to build positive connections between thoughts, emotions, and behaviors.

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CBT challenges negative or distorted thoughts and helps align people with a more accurate picture of reality. This is helpful for those with DID because dissociation makes it difficult to know what’s real.

Dialectical Behavioral Therapy

Dialectical behavioral therapy (DBT) is a kind of talk therapy that teaches patients to accept and work with their emotions rather than fight them.

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It uses the thought-emotion-behavior connection of CBT but has an emphasis on validation and acceptance. This can be powerful for those experiencing DID because DID is often talked about as something to be afraid of. 

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DBT acknowledges the fact that it’s hard to work on yourself without first accepting your problems are real and that’s okay. When difficult emotions and thoughts are accepted your distress tolerance should increase and you’ll be better equipped to work through these difficult realities.

Trauma Therapies

Trauma therapies like psychodynamic therapy and eye movement desensitization and reprocessing (EMDR), are also helpful for those with DID.

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EMDR uses eye movement to explore and reduce stress associated with traumatic memories. Someone with DID may not be able to access most traumatic memories. Therefore, it may be necessary to explore trauma outside of EMDR before starting this treatment. However, some have noticed a revealing quality to this treatment.

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Psychodynamic psychotherapy helps patients explore and understand their unconscious selves. This helps people with DID better understand why their disorder developed, who their alters are, and how to move forward.

Medical Treatment for DID

There are no medical treatments for DID, but certain antipsychotics, antianxiety, and antidepressants can help regulate chemicals within the brain and help balance moods.

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Whether or not any of these medications will be prescribed to a patient during DID treatment will be up to the patient and their care provider.

Integration

As the name suggests, integration is the merging of all alternate identities into a single being. Integration looks like accepting every alter as a part of a whole. 

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Integration may be seen as the final step of DID treatment. However, it’s difficult and requires a lot of treatment before attempting. Some people may also choose not to integrate and instead seek to create harmony between their alts.

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For integration to occur, trauma must be processed. This requires a healthy relationship with a therapist and years of practice. For some, it may never happen. For others, they may not want to integrate.

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If integration is successful, the host will no longer be able to communicate with their alters, and their alters will no longer be able to front. Instead, the alters will become one with the host. This doesn’t mean the host will inherit their mannerisms or ideals.

Start Treatment At Sequoia Behavioral Health

Most people with DID will not recognize their condition without clinical help. If you’re a family member or friend of someone with DID. you probably didn't know until a diagnosis came.

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If you’re looking for a place where you or your friend can find DID treatment, Sequoia Behavioral Health can help. Our residential treatment facility is designed to feel like a home away from home while also offering a space to heal.

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When you arrive at our facility you’ll be assessed to find out which treatments, medications, and recreational activities you’ll be enjoying. We build a customizable program that fits your needs.

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Contact us to begin the process.

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